GLODERM Mentee Application Form

Introduction

Please watch this guidance video from Dr Esther Freeman, Past-Chair of GLODERM, and Founder of the GLODERM Mentorship Programme.

Eligibility

Please complete and confirm the following information:

I confirm that I am on an eligible dermatology pathway.

Yes

Eligible pathways include:
- Physician (including MMed, MBBS, MD or equivalent) working on a global health dermatology project;

- Individuals in the final years of recognised dermatology training pathway, including dermatology diplomas;
- Practicing dermatologists looking to develop expertise in global health dermatology, including early-stage specialist dermatology providers and career switchers. Must be within five (5) years of completing their dermatology training.

PLEASE NOTE: This programme is not for medical students. If you do not meet the eligibility as stated above, unfortunately we will not be able to accept your application.

Confirmation of understanding

Please tick all the boxes below to confirm your understanding of the requirements of this programme.

I understand that this is not a programme for developing clinical skills.

Yes

I understand that this is a 12-month virtual programme and that if selected I can meet this time commitment of monthly virtual meetings, regular sessions with my mentor and an in-person training.

Yes

I understand and acknowledge that I will be required to travel internationally to attend the GLODERM Leadership Development Retreat in Moshi, Tanzania for one-week in January 2026.

Yes

I understand and acknowledge that I will be required to travel internationally to attend the World Congress of Dermatology in Guadalajara, Mexico from 21-26 June 2027.

Yes

I understand that failure to complete the programme will require me to return all the financial support I have received.

Yes

I confirm that I work in the public sector or conduct a project in the public sector or in underserved communities/global health dermatology.

Yes

I confirm that I live or work in resource-limited settings. (Exceptions may be made for those in high-income countries if they work with underserved populations, such as indigenous or native communities).

Yes

I will undertake GLODERM monitoring, and evaluation activities as required. This may include written reports, interviews, and video recordings.

Yes

Please upload a letter of consent.

Applicants are required to submit a written letter of consent from their institution. The letter must include the following:

1. The letter must be dated and signed or stamped on official institutional letterhead.
2. Approval to attend the following in-person events:
GLODERM Leadership Development Retreat - Moshi, Tanzania (one-week in January 2026).
World Congress of Dermatology - Guadalajara, Mexico (21-26 June 2027).
3. The letter must be signed by a senior colleague or an authorised institutional representative.

For applicants conducting a project in the public sector but who are privately employed or self-employed, the letter must confirm permission to attend both events in-person and be written by a peer in a similar or senior administrative role. The letter cannot be self-written.

Note: Applications without a valid letter of consent will not be considered.

To begin, we would like to hear about your academic and professional background.

This section covers the essential details, including your contact information to update you on the outcome of your submission.

Your details

Your First Name

Your Last Name

Your Email Address

Your Gender

In which country do you primarily live/work?

With which institution(s) are you affiliated?

Please select the appropriate categories for those affiliations:

Your experience

What is your level of dermatology experience?

If you select ‘dermatology residency’, please keep in mind this is referring to a dermatology residency specifically for physicians, e.g. MD or MMED qualifications or similar - NOT clinical officers or nurses

You have selected "Dermatology residency (in progress)" above - please confirm your current year in residency. PLEASE ANSWER WITH A NUMBER ONLY

You have selected "Dermatology residency (completed)" above - please confirm how many years out of training you are. PLEASE ANSWER WITH A NUMBER ONLY

Please state any relevant diplomas, certificates, and educational degrees below

Please list any scientific publications that you have been involved in (3 maximum)

We'd like to get to know you better.

This section gives you the opportunity to tell us more about yourself and why you want to become a GLODERM Mentee.

Why are you interested in global health dermatology and joining the GLODERM Mentorship Programme?

200 words remainingMaximum 200 words

What are the top 3 skills in global health dermatology that you wish to gain from this Mentorship Programme and why?

300 words remainingMaximum 300 words. Some examples are: writing publications, conducting peer reviews, writing grant and funding proposals, setting up training projects, building community outreach educational projects, policy design and implementation, leadership skills, public speaking, and strategic partnership development

Please select 3 sub-specialities of global health dermatology that you are interested in learning about within this Mentorship Programme (select up to 3 choices by holding the Control key)

Motivation

Look into your crystal ball... and tell us about the future. This section is all about what makes you different.

Why should you be part of this Mentorship Programme, and how will you improve future skin health care in your community and beyond?

300 words remainingMaximum 300 words

Leadership experience

Being a visionary, but also being flexible, humble, creative, and collaborative are important personal traits in becoming a global health dermatology leader.

Can you give an example of a time where you demonstrated leadership in at least one of these ways? Please be as specific as possible.

Maximum 300 words

Programmes & projects

Is there a dermatology focused public health gap, problem in your community, or project you are working on that you wish to address or have already started working on?

Maximum 300 words. Please be as specific as possible with concrete steps regarding how you would progress or undertake your project/programme proposal.

Implementation

How will you implement what you learn from the Mentorship Programme to create sustainable change for your community or project in the future?

Maximum 300 words. For example, based on your own leadership skills and ambitions, relevant experience and interest in global health dermatology, creating change and impact in your community.

Confirmation

Please confirm the statement below and then submit your application.

I can confirm that the information I have submitted in this application form is accurate and true to the best of my knowledge.

Yes